Summary
Definition
History and exam
Key diagnostic factors
- fever
- symptoms of meningitis
- signs of meningitis
- symptoms of sepsis
- signs of sepsis
- symptoms of pneumonia
- signs of pneumonia
- symptoms of urinary tract infection
- signs of urinary tract infection
- symptoms of cellulitis
- signs of cellulitis
- symptoms of septic arthritis
- signs of septic arthritis
- symptoms of conjunctivitis
- symptoms of sinusitis
- signs of sinusitis
- symptoms of otitis media
- signs of otitis media
- symptoms of endometritis
- signs of endometritis
- signs of chorioamnionitis
Other diagnostic factors
- nonspecific signs of infection in neonate
- nonspecific signs of infection in older patients
- symptoms of intra-abdominal infection
- signs of intra-abdominal infection
- midgestation abortion or preterm labor
Risk factors
- 0 to 7 days of age
- maternal fever during labor
- premature rupture of membranes (PROM)
- previous baby with GBS disease
- maternal GBS colonization
- GBS bacteriuria during pregnancy
- preterm delivery (<37 weeks)
- low birth weight (<2500 g)
- deficient maternal-specific IgG at term
- twin sibling with GBS disease
- maternal age <20 years
- chorioamnionitis
- age >60 years
- pregnancy
- multiparity
- diabetes
- obesity
- advanced hepatic disease
- renal disease
- presence of central venous catheter
- urologic disorders
- break in skin integrity or skin ulcers
- neurologic disease
- immunosuppression
- nursing-home resident
- black or Hispanic race
- malignancy
- obstetric manipulation
- presence of urinary catheter
- HIV infection
- trauma
- asthma
- consumption of placenta capsules
Diagnostic tests
1st tests to order
- CBC
- BUN
- serum electrolytes
- serum glucose
- coagulation studies
- LFTs
- C-reactive protein (CRP)
- blood culture
- cerebrospinal fluid (CSF) Gram stain
- CSF culture
- CSF cell count and differential
- CSF glucose and protein
- antigen detection in CSF
- Gram stain and culture of other sterile body fluids
- chest x-ray
- plain joint and/or bone x-ray
- CT head
Tests to consider
- echocardiography
- MRI
Treatment algorithm
early- or late-onset confirmed GBS neonatal infection (0-89 days of age)
infants and children
adults: nonpregnant
adults: pregnant and postpartum
Contributors
Authors
Brendan Healy, MBChB, BSc (Hons), MRCP, FRCPath
Consultant in Microbiology and Infectious Diseases
University Hospital of Wales
Cardiff
UK
Disclosures
BH has received honorarium and has been reimbursed for attending conferences from AbbVie (hepatitis C), Gilead Sciences (hepatitis C), Bristol Myers Squibb (hepatitis C), and Tillotts Pharma (fidaxomicin). BH declares that he has no competing interests in relation to the work carried out for this topic review, Group B streptococcus.
Acknowledgements
Dr Brendan Healy would like to gratefully acknowledge Dr Susannah Froude and Dr Harriet Hughes, previous contributors to this topic. We would also like to gratefully acknowledge Dr Benjamin D. Lorenz for his contributions to this topic.
Disclosures
SF declares that she has no competing interests. HH declares that she has received funds from Gilead and Biocomposites related to conference registration, travel, accommodation, and speaker fees.
Peer reviewers
William A. Petri, Jr, MD, PhD, FACP
Chief and Professor of Medicine
Division of Infectious Diseases and International Health
University of Virginia Health System
Charlottesville
VA
Disclosures
WAP declares that he has no competing interests.
James R. Hanley, MD, FAAP
Attending Physician
Pediatric Emergency Medicine
Ochsner Foundation Hospital
New Orleans
LA
Disclosures
JRH declares that he has ownership of a limited amount of stock in various pharmaceutical companies, although no significant amounts of any company.
Kirsty Le Doare, BA, MBBS, MSc, PhD, FRCPCH
Professor of Vaccinology and Immunology
St George's, University of London
London
UK
Disclosures
KLD declares that their institution has received funds for GBS vaccine clinical trials; she has not received personal funds.
References
Key articles
American Academy of Pediatrics. Group B streptococcal infections. In: Committee on Infectious Diseases, American Academy of Pediatrics, Kimberlin DW, Barnett ED, et al. Red book: 2021-2024 report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: AAP; 2021:707-13.
The American College of Obstetricians and Gynecologists. Prevention of group B streptococcal early-onset disease in newborns: ACOG Committee Opinion Summary, Number 797. Obstet Gynecol. 2020 Feb;135(2):489-92.Full text Abstract
National Center for Health Statistics. Active bacterial core surveillance (ABCs) report: emerging infections program network - group B streptococcus, 2018 [internet publication].Full text
Royal College of Obstetricians and Gynaecologists. The prevention of early onset neonatal group B streptococcal disease. Green-top guideline no. 36. Sep 2017 [internet publication].Full text Abstract
Ohlsson A, Shah VS. Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database Syst Rev. 2014 Jun 10;(6):CD007467.Full text Abstract
Puopolo KM, Lynfield R, Cummings JJ, et al. Management of infants at risk for group B streptococcal disease. Pediatrics. 2019 Aug;144(2):e20191881.Full text Abstract
American Society for Microbiology. Guidelines for the detection and identification of group B streptococcus. 29 July 2021 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Sepsis caused by other organisms
- Endocarditis caused by other organisms
- Neonatal cytomegalovirus (CMV) infection
More DifferentialsGuidelines
- Guidelines for the detection and identification of group B streptococcus
- Prevention of early-onset group B streptococcal disease in newborns
More GuidelinesPatient information
Cellulitis and erysipelas
Conjunctivitis
More Patient information
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